Riding Lesson Form pg. 2 | Blue Page Farms

Riding Lessons

PAGE 2

emergency contact

EC First Name

EC Phone

EC Last Name

Physician's Name

Physician's Phone

IN THE EVENT OF AN EMERGENCY I GIVE MY PERMISSION FOR EMERGENCY MEDICAL TREATMENT T BE GIVEN TO ME OR MY CHILD.

RIDING EXPERIENCE

Does the rider have friends or siblings already at Blue Page Farms

Yes

Name of friend or sibling

permissions and signatures

In consideration for the privilege of riding and/or working around horses at Blue Page Farms (“BPF”), located in Lebanon Tennessee, the undersigned assumes the unavoidable risks inherent in all horse-related activities, including but not limited to bodily injury and physical harm to horse, rider, and spectator, and does hereby agree to the following:

I agree to hold harmless and indemnify Dawn Page DBA, BPF, and any and all Dawn Page DBA, BPF employees, contractors, and volunteers, and further release them from any liability or responsibility for accident, damage, injury, or illness to the undersigned or to any horse owned by the undersigned or to any family member or spectator accompanying the undersigned on the premises.

I give Dawn Page DBA, BPF, its owners, employees, contractors, and volunteers my permission to initiate emergency first aid treatment for my children, my animals, and myself in case of an accident. They also have my permission to authorize emergency medical treatment by qualified medical personnel for my children or myself, and veterinary treatment by qualified veterinary personnel for my animals.

I understand that I am fully responsible for any guests that I may have on the property. I understand that I am fully responsible for informing my guest(s) of all risks related to the handling or riding of horses. I understand that I am fully responsible for informing my guest(s) about the horse’s temperament, training, and habits, and for determining that the guest is sufficiently experienced to ride the horse.

I acknowledge that at any point while on Blue Page Farms property I am subject to be photographed, videod, and/or my image taken. I understand that I have no right to the images/video/images taken and have no claim to them as my own.

There is a 24-hour notice for any canceled lesson. If less than 24-hour notice is given, you will forfeit the price of your lesson. We will be happy to schedule a make-up lesson within one week of the originally scheduled lesson. However, the make-up lesson cannot be used to replace a regularly scheduled lesson.

By signing below I certify that all the information above is correct and true to the best of my current knowledge.

Your Signature

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Riding Lessons

PAGE 2

emergency contact

RIDING EXPERIENCE

permissions and signatures

pg. 2

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